Community Health Assessment & Community Health Improvement Plan 2019-2021 (CHA/CHIP)

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COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

The mission of the Erie County Department of Health (ECDOH) is to promote and protect the health, safety, and well-being of Erie County residents through active prevention, education, enforcement, advocacy and partnerships. 1

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

PART A

A Message to the Community

The Erie County Department of Health worked with Kaleida and Catholic Health Systems, and a diverse group of community partners to create the Erie County Community Health Assessment & Community Health Improvement Plan 2019-2021 (CHA/CHIP). The CHA/CHIP is a comprehensive review and analysis of health status indicators, public health, socioeconomic, demographic and other qualitative and quantitative data from the service area of Erie County, NY in alignment with the New York State Department of Health’s 2019-2024 Prevention Agenda.

This report utilized primary (surveys, interviews and focus groups) and secondary (data from third party sources, i.e., US Census Bureau) disease incidence and prevalence data for Erie County. The data was reviewed and analyzed and used to strategically identify community health priorities, develop interventions, and commit resources to improve the health status of the region.

The CHA-CHIP can be used as a resource for health care providers, policy makers, social service agencies, community groups/ organizations, religious institutions, educational institutions, businesses, and consumers who are interested in working toward improving the health status of Erie County and the overall quality of life of its residents. It is the intent of the ECDOH and the community partners that worked with them to create this report, that the information presented is not only a useful community resource, but is a catalyst for new ideas, effective collaborations, interventions and campaigns

Partner Organizations Erie County Department of Health

Kaleida Health Systems

Catholic Health Systems

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

ACKNOWLEDGEMENTS

Thank you to all of our community partners that came together to assist with the planning and completion of the Erie County Department of Health’s Community Health Assessment and Community Health Improvement Plan. The information in this document would not be possible without the support and contributions of our valued community partners as well as the authors of previously produced documents.

The CHA and CHIP Planning Group & primary contributors:

Name Organization Email

Kelly Asher ECDOH [email protected]

Kelly Fletcher ECDOH [email protected]

Cheryll Moore ECDOH [email protected]

John Gaeddert ECDOH [email protected]

Roger Duryea CHS [email protected]

Yvonne Askew CHS [email protected]

Laurene Tumiel-Berhalter UB Family Medicine [email protected]buffalo.edu

Jonathan Lindner Buffalo State [email protected]

Alan Delmerico Buffalo State [email protected]

Renee Cadzow D'Youville College [email protected]

Mary K Comtois United Way [email protected]

Bartholomew Rodrigues CHS [email protected]

Kathleen Tompkins Kaleida Health [email protected]

Megan Wilson UB Family Medicine [email protected]

Stephanie Valenzuela CHS [email protected]

Lisa Neff American Heart Association [email protected]

Michele Mercer Millennium CC [email protected]

Michael Nanfara Program Coordinator PHC [email protected]

A special thanks to:

The Public Health Alliance Population Health Collaborative (WNY region PHIP) The Erie County Medical Examiner’s Office Erie County Department of Health Epidemiology The Opiate Task Force

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

Executive Summary

The Prevention Agenda is a six-year effort to make New York the healthiest state. Developed in collaboration with 140 organizations, the plan identifies New York’s most urgent health concerns, and suggests ways local health departments, hospitals, and partners from health, business, education, and community organizations can work together to solve them. The New York State Department of Health’s 2019-2024 Prevention Agenda serves as the blueprint for state and local action to improve the health of New Yorkers in five priority areas and to reduce health disparities for racial, ethnic, disability, socioeconomic and other groups who experience them.

This report is a compilation of the results of the Community Health Assessment (CHA) conducted by the Erie County Department of Health, Kaleida Health and Catholic Health Systems and the Erie County

Department of Health’s Community Health Improvement Plan (CHIP) resulting from the CHA. Contained in this report is a detailed assessment of the health status of the residents of Erie County and a prioritization of the health concerns identified. This report also contains the Erie County Department of Health’s CHIP and implementation strategy for the next three years.

In the spring of 2018 the Erie County Department of Health brought together the local hospital systems, Kaleida Health and Catholic Health, as well as decision makers from government agencies, educational institutions, service providers, community based organizations agencies and the Public Health

Collaborative (PHC) to create the CHA and CHIP Planning Group (CCPG). The group was tasked with assessing and prioritizing community health needs and priorities and selecting at least, two, common priorities areas from the NYS Prevention Agenda The selections would guide the Erie County Department of Health through the Community Health Improvement Plan process as well as Kaleida and Catholic Health Systems through their individual Community Service Plans. (To view specific partner and their roles please see Appendix A, page 6)

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

Although the hospitals systems and the Erie County Department of Health completed the Community

Health Assessment together; and together, agreed on and selected the priority and focus areas that they would work collaboratively to address in their Community Service Plans and Community Health Improvement

Plan (respectively), the decision was made for each partner to submit their own report to New York State

Department of Health. The partners believed doing so would allow each organization to expand their focus, interventions and work plans beyond those the partners would select through the collaborative process.

Social determinants of health were given special attention through the assessment process.

The assessment was planned and conducted using the NYS Prevention Agenda and its five identified priority areas as a guide: (1) prevent chronic diseases; (2) promote a healthy and safe environment; (3) promote healthy women, infants and children; (4) promote well-being and prevent mental health and substance use disorders; and (5) prevent communicable diseases. Aside from health data; demographics, geography and socio-economic indicators were used to do the assessment. Other areas included or addressed in this report are social determinants of health, evidence based interventions, prioritization of needs and resources and capacity.

Again, the Community Health Assessment (CHA) was conducted to identify significant health needs as outlined by New York State Department of Health’s 2019-2024 Prevention Agenda and, from that assessment, select at least two Prevention Agenda Priority areas to focus on collaboratively. The CHA & CHIP Planning

Group (CCPG) developed a data collection plan which included a consumer survey, community and provider input from several community and provider focus groups and data gathered from vital statistics, epidemiology data bases, research studies, hospitals and other sources (a full list of sources can be found in the data analysis section of the CHA). The gathered data was then used to conduct a comprehensive and reliable assessment of the population’s health status and health challenges. Regional, state, county, sub-county data and data

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH gathered in the Community Health Survey, and the Community Conversations developed by the group, were analyzed to review trends and compare Erie County’s health indicators to state goals and local averages.

The group developed a rating/ criteria prioritization system (described more thoroughly in the data analysis section of this report) to identify the biggest health concerns/needs in Erie County; prioritize those concerns/needs and decide which priorities our organizations had the capacity to address. Following are the top three priorities areas, as aligned with the NYS Prevention Agenda, selected by Erie County Department of

Health (ECDOH), Kaleida Health Systems and Catholic Health Systems to work on for the next three years: (1) prevent chronic diseases with a disparity concentration on poverty; (2) promote Healthy Women, Infants and

Children; and (3) promote well-being and prevent mental health and substance use disorders with a disparity.

ECDOH has selected the following priorities, focus areas and goals:

Priority Area 1 - Prevent Chronic Disease (addressing the disparity of poverty); focus area 1: Healthy

Eatinand Food Security; Goal: 1.1: increase access to healthy and affordable fruits and vegetables; focus Area

2: Physical Activity; Goal: 2.2: promote school, child care, and worksite environments that support physicalactivity for people of all ages and abilities; focus area 3: Tobacco Prevention; Goal: 3.1: prevent initiation of tobacco use, including combustible tobacco and electronic vaping products by youth and young adults; Goal 3.2: promote tobacco use cessation, especially among populations disproportionately affected by tobacco use including: low SES, frequent mental distress/substance use disorder; LGBT; and disability; focus area 4: Preventive Care and Management; Goal 4.2: increase early detection of CVD, diabetes, prediabetes and obesity; Goal 4.4: improve self-management skills for individuals with chronic conditions;

Priority Area 2 – Promote Healthy Women, Infants and Children; Focus area 2: Perinatal & Infant Health;

Goal: 2.1: Reduce infant mortality and morbidity 2.2 Increase Breastfeeding; Focus Area 4: Cross Cutting

Principles applied for Healthy Woman, Infants, & Children.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

Priority Area 3 – Promote Well-being and Prevent Mental and Substance Use Disorders: Focus Area 2:

Prevent Mental and Substance Use Disorders; Goal 2.2: Prevent opioid and other substance misuse and deaths

The evidence based and evidence informed interventions to address the focus areas and goals were selected based on how well they addressed the established goals, if the intervention was already being used by the partner’s agencies; the partner’s capacity to implement the intervention, and the cost of the intervention. The

CATCH program will be used to address Priority Area 1 Goal 2.2

Another CATCH program, The CATCH My Breath will be used, along with the American Heart Association’s Quit Lying program to address priority area 3, goal 3.1. Other evidenced based programs utilized in ECDOH’s CHIP are Stanford’s

Chronic Disease Self-Management Program (CDSMP) and Diabetes Self-Management Program (DSMP) and the National

Diabetes Prevention Program (DPP) to address priority area 1 goal 4.2 and goal 4.4.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

Hospital and Community Partners

Although the hospitals and the Erie County Department of Health will each be submitting their own

Community Health Improvement Plan, they worked together to develop their plans, partnered on some initiatives and made certain that their priorities and interventions aligned and complemented each other. The collaborative approach taken will leverage the efforts and resources of all health organizations in the community, resulting in increased effectiveness and sustainability of initiatives and interventions, reduced service duplication and clear identification of system gaps.

Tracking Evaluation and Sustainability

To evaluate the impact, the 2019-2021 CHA-CHIP progress and improvement will be tracked through annual evaluation of the following data sources: NYSDOH Prevention Agenda dashboard data, County Health

Rankings, EC Medical Examiner reports, hospital utilization data, along with other local data sources.

The partners will continue to communicate and meet at least once per year during the implementation period of the 2019-2021 CHIP. At each meeting, progress metrics will be reviewed to providing opportunity for valuable conversation around quality improvement, including identification of barriers and sharing best practices. ECDOH will compile a brief progress report, share it with partners and post it on the ECDOH websites where the CHA and CHIP documents are posted in order to be transparent and accessible to the community.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH B. Community Health Assessment

Geography

Erie County is the largest metropolitan county in upstate New York with a population of 922,5781 and covering 1,044 square miles. Erie County is located in western New York, bordered to the west by Lake Erie and the Niagara River, and shares an international border with Canada. Several bridges span the Niagara River and provide convenient access and trade for residents of the United States and Canada. Niagara County lies to the north, Genesee and Wyoming Counties to the east, and Cattaraugus and Chautauqua Counties are to the south.

There are three cities in the County. Buffalo is the second largest city in the state and the largest city in the region with a population of 256,304.1 Buffalo serves as the County seat. In addition, there are 16 villages, 25 towns, and two Native American Indian reservations within the County.

Erie County is largely an urban County with the majority of the population living within the cities and surrounding communities.

That being said, there is also a significant rural population that resides outside the first and second ring suburban areas whose needs are addressed differently due to sheer geographic distances.

Resident Demographics

The population of the County appeared to be decreasing for the first half of the decade but, as the end of the decade nears, the population in Erie County appears to be growing slightly. According to the US Census, in 2010 the population of Erie County was 919,040; in 2018 the population was estimated at 922,578; about a 1% increase in population.

76% of the Erie County population is non-Hispanic Whites, 14% non-Hispanic African Americans, 5.2% Hispanic, 0.7% American Indian/Alaska Native, and 3.4% Asian.

The City of Buffalo population is 47.4 % White; 36.7 % Black or African American; 11% Hispanic; 0.5 % Native American/Alaska Native; 5.6 % Asian; 0% is Native Hawaiian and/or Pacific Islander, and 5.8% is some other race. An estimated 4.0% is one or more races.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

Upon deeper examination of the demographics of the County, there are significant differences in the racial composition of the City of Buffalo as compared to the rest of Erie County. The City of Buffalo is characterized by a much higher percentage of African Americans (36.7) and Hispanics (11.3%) than the county as a whole.

According to the 2014 -2018 US Census Bureau American Community Survey an estimated 92.9 percent of the people living in Erie County, New York are U.S. natives. 80.6 percent of the Erie County, New York population is living in the state where they were born. Approximately 7.1 percent of Erie County, New York residents in 2014-2018 are foreign-born. 51.7 percent of foreign born are naturalized U.S. citizens and an estimated 68.3 percent entered the country before the year 2010. Foreign-born residents of Erie County, New York come from different parts of the world. The bar graph on the right displays the percentage of foreign born from each world region of birth in 2014- 2018 for Erie County, New York.

The west side of Buffalo is home to a large immigrant and refugee population where there are 33 ethnicities and more than 70 languages and dialects spoken. Just south of Buffalo Lackawanna, New York, is home to a large Arab American community, many of whom do not speak English. Languages Spoken at Home Other Than English Percent

According to the 2018 American Community Survey, among people at least five years old living in Erie County, Spanish 3.4 New York in 2014-2018, 10.5 percent spoke a language other than English at home. Spanish was spoken by 3.4 percent of people at least five years Other Indo-European languages 3.5 old; 3.8 percent reported that they did not speak English "very well." Asian and Pacific Islander languages 1.9 The disparities in health outcomes associated with urban, low income, racial minorities in the literature are prevalent and apparent when looking at data for the inner city residents. Although there is a relatively small Other languages 1.6 percentage of a minority population other than black, they are composed of the newly settling refugee populations that are bringing their existing health issues Table source: 20-14- 2018US Census Bureau American Community Survey common to refugees with them such as TB and Giardia, unfortunately the refugees are quickly converting to the unhealthy American behaviors which contribute to high rates of chronic disease as they become assimilated to the way of life in the United States.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

Income Median Household Income The median household income in Erie County is $55,673 which is less than that $70,000.00 $65323 of New York State but significantly higher $60,000.00 $55673 than that of the City of Buffalo, which is $50,000.00 $35,893. Disparities associated with low socioeconomic status are apparent even $40,000.00 $35,893 without the comorbidities of minority $30,000.00 ethnicity, lack of education and $20,000.00 inadequate housing. $10,000.00 To further compound this problem there $0.00 is the discrepancy between male and Median Buffalo Erie County New York State female earnings for the same work. The Household city of Buffalo has a large contingency of Income 2014- Source: US Census single parent families with single women 2018 holding the title of head of household. Among those employed full time, the median earnings for males is $50,062. Disparately, the median earnings for a female full-time worker are $37,639, 25% less than that of their male counterpart. The sustained economic depression created by this income disparity further exacerbates existing health concerns leading to further disparities in health status.

Pay Equity between genders is an ongoing concern. Erie County continues fighting this disparity through efforts of the Erie County Commission for the Status of Women. The Commission was established by a unanimous vote of the Erie County Legislature in 1987 to remove gender based inequities for women. In 1988, the Commission became a department of Erie County government. As noted on the Commission’s website:

▪ Women comprise 52% of Erie County's total population, 49.7 percent of its labor force, 59% of senior citizens, and 53% percent of the county’s registered voters. ▪ Women age 18-24 years: over 4000 have not graduated from high school, over 10,000 have a high school or equivalency diploma, over 22,000 have some college or associates degree and over 8600 have a Bachelor's degree or higher. ▪ The median annual earnings for women working full-time are $41,317, for men, $53,266. ▪ Median weekly earnings for women working full-time is $794 vs. $1024 for men ▪ One in six girls and women live at below the poverty level in Erie County. ▪ 1.2% of pregnancies are to teenage mothers, age 15-19, in Western New York. ▪ In Erie County in 2018 more than 10,000 incidents of domestic violence were reported to law enforcement. ▪ Of the almost 60,000 veterans in Erie County, approximately 3800 are women. ▪ Of the returning women veterans, 40% have mental health issues including depression, Post-Traumatic Stress Disorder and Military Sexual Trauma. ▪ 30% of families in Buffalo live in poverty with over 63% of families having women as head of household. ▪ Approx. 1,000 children are born each year to mothers without a high school diploma. ▪ 25% of women in Erie County do not receive prenatal care.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH Poverty When looking at all families in Erie County, 14.9% are living below the poverty level which is similar to the NYS percentage of 15.1%. In the city of Buffalo this number jumps to 30.9% of the population. For families in Erie County as a whole, with children under 18 years of age, 18.4% live below the poverty level. The likelihood of families living below the poverty level is compounded for single, female headed families. 31.4% of families in Erie County have a single, female head of household and 12,898 of these families live below the poverty level.

Erie County’s per capita income in 2018 dollars (2014-2018) was $32347. In the City of Buffalo, poverty is significantly more prominent. In Buffalo the per capita income is $23,397 almost $9,000 less than the County. The gap has widened by almost$200 between the County of Erie and the City of Buffalo since the 2016 -18 CHIP i

Children particularly are affected as shown in the accompanying map. The detailed view of the City of Buffalo visually emphasizes the serious financial disparities of families with children as compared to Erie County. The residents most in need of assistance reside in a relatively compact geographic segment of the county.

Disability In Erie County, New York, among the civilian noninstitutionalized population in 2014-2018, 13.2 percent reported a disability. The likelihood of having a disability varied by age - from 4.8 percent of people under 18 years old, to 10.7 percent of people 18 to 64 years old, and to 32.9 percent of those 65 and over.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH Households and Families Erie County: In 2014-2018, there were 387,847 households in Erie County. • The average household size was 2.30 people. • Families made up 59.0 percent of the households in Erie County, New York. o married-couple families (41.6 percent) and o other families (17.4 percent). o Female householder families with no husband present and own children under 18 years are 7.2 percent of all households. • Nonfamily households made up 41.0 percent of all households in Erie County; 26.5 percent of all households have one or more people under the age of 18; • 29.8 percent of all households have one or more people 65 years and over. • In Erie County, New York, 12,825 grandparents lived with their grandchildren under 18 years old. Of those grandparents, 41.4 percent were responsible for the basic needs of their grandchildren.

City of Buffalo: In 2014-2018, there were 110,701 households in Buffalo city, New York. • The average household size was 2.24 people. • Families made up 50.8 percent of the households in Buffalo city, New York. o married-couple families (24.5 percent) o Other families (26.3 percent). o Female householder families with no husband present and own children under 18 years are 12.6 percent of all households. • Nonfamily households made up 49.2 percent of all households in Buffalo city, New York. • 27.7 percent of all households have one or more people under the age of 18; • 22.8 percent of all households have one or more people 65 years and over. • In Buffalo, New York, 4,829 grandparents lived with their grandchildren under 18 years old. Of those grandparents, 43.7 percent were responsible for the basic needs of their grandchildren.

Education According to NYSED in 2014-2015, the graduation rate for the Buffalo Public Schools was 57%. This statistic both reflects and predicts poor social and emotional health and well-being in this population and once again reflects the effects of socioeconomic and racial disparities. In response to the low high school graduation rates in the city of Buffalo, the high unemployment rates, and involvement in criminal activities by the school aged youth the Buffalo Public School System, the City of Buffalo, the County of Erie, assorted philanthropic foundations and many community based organizations partnered to form the Say Yes to Buffalo Collaborative.

City of Buffalo & NYS 2019 Graduation Rate Source: NYS Department of Education

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

City of Buffalo & NYS 2019 Graduation Rate by Race/Ethnicity Source: NYS Department of Education

The holistic, year-round support Say Yes Buffalo and its partners provide to Buffalo Public School District students throughout their K-12 years and beyond is working. Acting on their belief that every student can graduate high school and college when given the proper supports, resources, and opportunities is already paying dividends. According to the New York State Education Department (NYSED) the 2018-19 graduation rate for BPS was 65% an increase of 8%.

“Say Yes Buffalo” will continue to provide comprehensive supports, including locally funded tuition scholarships of nearly 100 colleges and universities for those who meet residency, graduation and admission requirements. These supports are aligned with what research indicates is needed to enable every child in the program to achieve his or her potential.ii The chart below shows the disparity in graduation rates between different racial/ethnic groups. American Indian/Alaskan Native students have the highest graduation rate at 82% and the Hispanic/Latino students have the lowest at 57%.

The total school enrollment in Erie County, New York was 218,807 in 2014-2018. Nursery school enrollment was 11,996 and kindergarten through 12th grade enrollment was 138,001. College or graduate school enrollment was 68,810. County of Erie & NYS 2018-19 Graduation Rate by Race/Ethnicity Source: NYS Department of Education

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

County of Erie & NYS 2018-19 Graduation Rate Source: NYS Department of Education

For individuals over the age of 25, Table 4 compares the highest Educational Achievement in NYS, Erie County, & Buffalo among residents educational level achieved in >25yrs NYS, Erie County and the City of Demographics and Educational Level of NYS Erie County Buffalo Buffalo. Erie County had an Residents increase of 1% in number of High School Graduates 85.6% 91.4% 82.7% high school graduates and a 2.1% increase in those Bachelor’s Degree or Higher 34.2% 33.7% 24.6% completing a Bachelor’s Degree Table 4 or higher since the 2017 – 2019 Community Health Assessment (CHA). The numbers for NYS and the City of Buffalo have remained the same. The number of Erie County Residents completing high school is 7 % higher than number for NYS and 9% higher than the number for the City of Buffalo. In the 2017-2019 CHA the number completing higher education was almost 3% lower than NYS numbers, but since then it has moved to less than .5 % than in New York State, and even lower in the City of Buffalo.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH Employment Through the early to the later part of the 20th Century, Erie County was primarily a blue collar community. Throughout most of the century the steel and auto industries were the primary sources of employment for many residents. During the 1980’s many companies including Bethlehem Steel and Republic Steel, two of the largest employers in Erie County, closed the majority of their operations and were forced to lay off a preponderance of their workforce. Although the auto manufacturing plants still operate in Buffalo, Chevy and GM Power train, these once large employers have significantly reduced their workforce over the last 30 years. As factories/facilities closed, or reduced their workforce people took lower paying jobs or left the area all together. Due to the diverse nature of this population and the numerous variables affecting the delivery of services, it is a much more complex problem than a quick analysis would show.

The primary industries in Erie County have since shifted from blue collar manufacturing industries to education and health services, trade, transportation and utilities. The number of manufacturing jobs fell from over 67,742 in 2000 to 47,681 in 2011 to 46,673 in 2014 and rose again slightly in 2019 to 48,900. Conversely, in 1975 there were approximately 67,000 jobs in the service industry compared to over 208,000 service industry jobs in 2018. (Source: US Bureau of Labor Statistics)

Employment in Erie County by Industry Industry Population Percentage and Occupation (Source: American Educational Services, health care and social 124,916 28.5 Community Survey, 2013 – 2018- 5 year assistance estimates) Manufacturing 46,673 10.7 Retail Trade 50,847 11.6 In New York State the unemployment Professional, scientific, management, rate was estimated at 4.0% in November administrative, and waste management 42,639 9.7 2019. Erie County’s unemployment rate services during the same time period was similar Arts, entertainment, recreation, 40,837 9.3 at 3.8%. The City of Buffalo accommodation and food services unemployment rate was similar to the Finance, insurance, real estate, and rental and 33,445 7.6 County and NYS at 3.9% during the same leasing period.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

Since a high of 9.2% in all of Erie County in 2013 to the 3.8% of November 2019 (up.2% since10/19), many changes have occurred to the Buffalo and Erie County job landscape, including the building occurring in the Buffalo Niagara Medical Corridor in downtown. Construction and skilled trade jobs are opening but there are not enough skilled laborers to in the Buffalo/ Erie County area to fill them. We have a skilled labor deficit.

Since December 31, 2018 private sector jobs in the Western New York region increased by 2,900 or 0.5 percent, to 553,700 by December 31, 2019. Employment gains were largest in educational and health services (+3,600), leisure and hospitality (+1,300), trade, transportation (Tractor Trailer drivers are desperately needed) utilities (+600), natural resources, mining and construction (+500) and financial activities (+400). Job losses were greatest in manufacturing (-2,400) and professional and business services (-900). Over the past year there has also been an increase in Government sector jobs increased (+300). There are a number of well-paying positions available for truck drivers, welders, electricians, carpenters and virtually anything in the medical field. Employers are constantly looking for skilled workers, but there are not enough of them to fill the available positions. There is a gap in the number of job seekers possessing the skills needed and the number of jobs that need workers that possess these skills. Employers cannot fill all of their positions.

Housing Housing costs in Erie County have been among the lowest in the northeast. According to the American Community Survey, in 2011-2015, the median mortgage cost to homeowners was $1,256 per month. The median monthly cost for housing units without a mortgage was $501 and the median monthly cost for renters was $739. This is notably lower that New York State comparisons in the same categories of $2,022; $709; and $1,132 respectively. However, as of December 31, 2019, average rent for an apartment in Buffalo, NY is $950 which is an 11.79% increase from last year when the average rent was $838, and a 1.26% increase from last month when the average rent was $938. One bedroom apartments in Buffalo rent for $931 a month on average (a 10.96% increase from last year) and two bedroom apartment rents average $983 (a 7.43% increase from last year).

Many Buffalo renters have reported seeing increased rents in their neighborhoods. This is concerning because housing costs for most renters in Buffalo are already unaffordable. Rental affordability is considered paying 30% or less of your household income on housing costs, including utilities. The majority of renter households in Buffalo pay more than this (see graph above). Worse yet, nearly one in every four Buffalo renter households pay at least half their household income on housing costs. 1 Households of color are disproportionately impacted by this problem (see graph below).2

Housing stock in Erie County is aging, particularly in the City of Buffalo. In a recent report from Business First, it was noted that Buffalo has some of the oldest housing stock in the country, second only to Scranton, PA. The city was not

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

affected by the housing boom and the subsequent housing bust experienced in the rest of the country in the past decade but in the past 5 years has experienced a renaissance in the neighborhoods surrounding the new Medical Campus and the historic West Buffalo communities. Housing costs in this region that have remained relatively stable over the past decade are now rapidly increasing in these communities as the popularity of these parcels increases. Investors are buying up the properties, renovating them and then renting them to young professional at 2 even 3 times the rate prior. This has displaced many of the community’s long-standing residents as they can no longer afford to rent.

Housing Cost Burden In 2014-2018, cost-burdened households in Erie County, New York accounted for 21.2 percent of owners with a mortgage, 14.6 percent of owners without a mortgage, and 50.0 percent of renters.

Erie County Housing Cost Burden Source: 2014-2018 US Census ACS Data

Health Insurance City of Buffalo Among the civilian noninstitutionalized population in Buffalo city, New York in 2014-2018, 94.6 percent had health insurance coverage and 5.4 percent did not have health insurance coverage. Private coverage was 49.8 percent and government coverage was 54.5 percent, respectively. The percentage of children under the age of 19 with no health insurance coverage was 2.0 percent.

Health Insurance Erie County Among the civilian noninstitutionalized population in Erie County, New York in 2014-2018, 96.3 percent had health insurance coverage and 3.7 percent did not have health insurance coverage. Private coverage was 71.5 percent and government coverage was 39.5 percent, respectively. The percentage of children under the age of 19 with no health insurance coverage was 1.8 percent.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH Transportation

Buffalo is home to one of the best public transit systems in the country, according to a 2016 study by Walk Score published by the online real estate agency Redfin. Buffalo's Metro Bus and Rail system ranked ninth among mid- sized U.S. cities with populations between 100,000 and 300,000 people. Metro received a transit score of 50.4, earning high marks for its accessibility to major attractions such as Canalside and events at the recently renamed KeyBank Center.

Although Buffalo’s transit system ranked high, Transportation is still a huge barrier to jobs and services. Many jobs are located far away from neighborhoods and sometimes, the bus line does not go all the way to where a good job is located. The cost of public transit creates barriers for everyone; employers, service providers and residents. Walkability of streets and sidewalks creates challenges to getting around within neighborhoods.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH Health Reportable Communicable Diseases in Erie County as of 12/6/2019

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH Other Reportable Communicable Diseases in Erie County as of 12/6/2019

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

Contributing Factors to Leading Causes of Death

Obesity and overweight are currently the second leading contributing factors leading to preventable death in the United States (US) and may soon overtake tobacco as the leading preventable cause of death.1 By the year 2050, obesity is predicted to shorten life expectancy in the US by 2-5 years.2 Obesity is a significant risk factor for many chronic diseases and conditions including type 2 diabetes, asthma, high blood pressure, high cholesterol, stroke, heart disease, certain types of cancer, and osteoarthritis.3-6 Increasingly, these conditions are being seen in children and adolescents.7,8 New York State ranks second among states in medical expenditures attributable to obesity at $11.1 billion.9 Creating community environments that promote and support healthy food and beverage choices and physical activity is a major goal in the effort to prevent and reduce the burden of chronic disease and a focus of the New York State Prevention Agenda 2019-2024. Maintaining healthy weight should start early in childhood and continue throughout adulthood.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

Data Source: SPARCS data as of August 2016

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

* The rate or percentage is unstable. S Data suppressed/ data do not meet criteria for confidentiality ~ White non-Hispanic, Black (including Hisp, Asian excluding NA Data do not meet the criteria for statistical reliability or data Pacific Islanders), and Hispanic quality, or data not available ^ APNCU: Adequacy of Prenatal Care Utilization Index Symbol Meaning for Health Indicator Table The mission of the Erie County Department of Health (ECDOH) is to promote and protect the health, safety, and well-being of Erie County residents through active prevention, education, enforcement, advocacy and partnerships. 28

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH Mental Health

Suicide Pinpointing the reasons that suicide rates rise or fall is challenging in part because the causes of suicide are complex. Risk factors include health factors (such as depression, substance use problems, serious mental illness and serious physical health conditions including pain), environmental factors (such as access to lethal means and stressful life events including divorce, unemployment, relationship problems or financial crisis) and historical factors (including previous suicide attempts, a family history of suicide and a history of childhood abuse or trauma).

Socioeconomic changes might be part of the puzzle. Globally, suicide rates have often fallen when living conditions have improved. And the reverse is also true. Princeton University economists Anne Case, PhD, and Angus Deaton, PhD, have shown that deaths from suicide, drugs and alcohol have risen steeply among white, middle-aged Americans since 2000 (PNAS, Vol. 112, No. 49, 2015). They argue these “deaths of despair” are linked to a deterioration of economic and social well-being among the white working class (Mortality and Morbidity in the 21st Century, Brookings Papers on Economic Activity, Spring 2017).

Limiting legal means While data from other countries can’t explain the rising rate of American suicides, they may hold clues about how to prevent them. One takeaway from the data both at home and abroad: Limiting access to means of death can make a real difference. When countries have made it harder to access a means of death, their suicide rates have declined. In England, people once could end their lives with carbon monoxide from toxic coal gas. When the country switched to less-toxic gas for heating and cooking, deaths from suicide dropped by 40 percent. In Asia, many countries saw suicide rates drop after making it more difficult to access toxic pesticides that are used in farming. Bridge barriers that prevent people from jumping have similar effects.

In the United States, more than half of all suicide deaths are the result of firearms. And there’s evidence that when access to guns goes down, so do suicide deaths. During the 1990s, household gun ownership fell significantly. During those years, deaths from suicide by firearm also decreased, while suicide by other means stayed about the same. The result: a notable drop in the overall suicide rate, from more than 12 per 100,000 in 1990 to just under 10.5 in 1999.

2019 95 Erie County Deaths by Suicide have continued to decline each year since 2016. 2018 97

2017 108

2016 97

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

Mental Health, Cont.

Mental health and substance abuse services paid with public funds are primarily provided through a system of contractors overseen by the Erie County Department of Mental Health in Erie County New York. They are the primary conduit of funding and service provision determination and oversight from the New York State Office of Alcohol and Substance Abuse Services (OASAS) and Office of Mental Health (OMH.)

The local OASAS funded substance abuse prevention providers have partnered together and with the Sheriff to implement an aggressive campaign to decrease underage drinking and DWI. Over the next three years these organizations will utilize multiple forms of media to promote social change, especially in our most socioeconomically depressed communities, to decrease the acceptability of alcohol consumption and subsequent activities, such as driving a car or boat while under the influence, and so change the long term outcomes of alcohol related incidents.

Crisis Services of WNY host the Erie County Suicide Prevention Coalition that is working to create awareness of the escalating problem in the community as well as to provide trainings for school personnel and child service agencies to increase the staff capacity to be aware of and deal with prevention of suicide in our community through an evidence based model of service delivery.

Crisis Services of WNY continues to operate a 24/7 hotline that can be utilized by the public if they are experiencing acute mental health issues that could lead them to contemplating suicide or other debilitating acts. This hotline is staffed with trained counselor to assist the person who is in need of help. They also operate an emergency outreach service to people who may be contemplating suicide. They will send out a team of two counselors to assess the client for their level of lethality. If necessary 911 will be called to have the client admitted for emergency psychiatric care.

Substance Abuse Erie County, like much of nation, has seen a significant increase in opioid overdoses in the past few years both from pill and heroin use which has in recent years transitioned to the opioid fentanyl and its analogues. As seen in the accompanying Erie County Medical Examiner’s Office chart, Heroin deaths increased 85% from 2012 – 2013 but since the inception of the Erie County Opiate Epidemic Task Force in 2016 until today in 2019, there has been a significant decrease in the numbers of deaths.

This period of increased deaths coincides with the implementation of the New York State prescription drug monitoring program, I-Stop that limited the accessibility of prescription opioids. Transitioning to illegal street drugs to feed the physical addition brings a whole host of additional problems to the individual, from acquiring blood borne pathogens, such as HIV and Hepatitis C, to the exacerbation of comorbidities such as mental health issues and chronic diseases.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

Erie County Opioid Epidemic Task Force: The Erie County Opiate Epidemic Task Force was created by Executive Order #014. The Erie County Opioid Epidemic Task Force was established by Erie County Executive Mark C. Poloncarz on January 19, 2016 to coordinate a response to the opioid crisis sweeping across Erie County. The Erie County Health Department has noted a sustained and growing number of opioid addicted persons in our community, identifying a public health crisis. The opioid crisis affects nearly every part of Erie County be it urban, rural, or suburban. Opioid addiction often starts in individuals who are prescribed opioid pain medications or who take opioid medication prescribed for other people and may progress to using illegally manufactured drugs, such as heroin. Dangerous and powerful opioids, such as fentanyl, are increasingly being found on our streets, in addition to heroin. No single strategy alone can address this complex, multifaceted issue. The coordination of the many individual anti-opioid initiatives currently being undertaken throughout Western New York is critically needed.

The Opioid Epidemic Task Force includes community experts from social service agencies, law enforcement, physicians, mental health and addictions providers, the health insurance industry, and members of victims’ families. The Task Force is composed of seven committees that meet regularly and report back to the group.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

The 7 Task Force Committees:

1. Provider Education & Policy Reform, led by Erie County Health Commissioner, Dr. Gale Burstein 2. Community Education, led by Barbara Burns of the U.S. Attorney General’s Office, Western Region of NY 3. Families and Consumer Support & Advocacy, led by Debra Smith, Parent Advocate 4. REAP Program, led by Dan Rinaldo of NYNJ-HIDTA (High Intensity Drug Trafficking Area) 5. Treatment Providers, led by Erie County Commissioner of Mental Health, Michael Ranney 6. Hospitals/ER ROI Project, led by Dr. Joshua Lynch of Kaleida Health & Millard Fillmore Suburban Hospital Emergency Department 7. Naloxone Access, led by Cheryll Moore of the Erie County Department of Health

New mixtures of drugs are being noted consistently in the toxicology reports including mixing the fentanyl analogues with cocaine. To address these new issues we will begin working with additional populations struggling with substance use disorder that may not be aware of the presence of opioids in their drugs.

Erie County has applied for and received numerous federal grant awards from the Department of Justice and SAMHSA to address the epidemic and has become a national model, working on all areas from prevention to treatment.

ECDOH is addressing this issue through a public health perspective and the implementation of evidence based harm reduction initiatives.

ESAP One initiative is the Expanded Syringe Access and Disposal Project (ESAP) project that provides access to clean syringes without a prescription and provides access to needle disposal sites with mailbox like kiosks in places where residents naturally go. There are currently more than 70 needle disposal sites in the Erie County at various sites including drugstores, street corners, universities and department stores. Additionally the county has partnered with local police agencies to have prescription drug drop boxes housed at the same sites as needle collection kiosks in selected areas. This initiative is helping to decrease the access to prescription opiates even further.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH Community Narcan Education and Distribution

Another project is the Opioid Overdose Prevention Program/Narcan Administration Project (OOPP) geared at first responders and general community members. The county is training and equipping all first responders interested in Narcan administration and overdose reversal. Mechanisms to get Narcan into the highest risk individuals’ hands including community trainings, and availability through community access Narcan sites.

Social Determinants of Health

After reviewing the primary and secondary and comparing it with the community survey results and the feedback from , the community focus groups and stake holder focus groups the following themes regarding barriers and challenges to being healthy emerged.

Financial

• High rent costs: rents, 21.2 percent of owners with a mortgage, 14.6 percent of owners without a mortgage, and 50.0 percent of renters are cost-burdened households. Meaning well over 30 percent of their income is spent on just the roof over their head . • high price of food and • lack of free or low cost exercise and physical activity programs, • working multiple jobs just to get by; • lack of access to healthy foods o proliferation of fast food restaurants in many neighborhoods and o No grocery stores nearby o lack of access to affordable foods;

Health care access difficulties • lack of choice for providers, • few PCPs and • virtually no specialists in many areas of Erie County, • health insurance premiums are higher than ever and they cover less • health insurance copays are too high • insurance does not cover needed vaccines or preventive health services, • long wait periods to get an appointment and • long wait periods while at the facility,

Safety • crime, violence and • crumbling infrastructure

Transportation • Existing public transportation doesn’t take you to where the jobs and services are • Can’t afford car payment and car insurance • Parking costs if you live and work near downtown

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

Behavioral • lack of motivation and priority - it is hard to be motivated to engage in healthy behavior when exhausted, stressed and just trying to survive • Addiction (all substances) and • Conflicting and confusing health messaging • Convenience and low cost of unhealthy food

Health disparities are evident in many areas of Erie County for a variety of contributing factors. Socioeconomic generational strife leads to significantly poorer health outcomes. Within Erie County there are zip codes with significantly lower socioeconomic status than the county as a whole. These zip codes are primarily within the City of Buffalo.

As a point of reflection, over 70% of the Erie County Department of Health clinic patients come from five zip codes in the City of Buffalo, 14204, 14206, 14211, 14212, and 14215. Unemployment is significantly higher in these zip codes than in the County, New York State, and the nation. Median household income and per capita income are about half of Erie County income levels in three of five of these zip codes. Race and ethnicity distributions are also very different in these zip codes as compared to Erie County, state, and national percentages. These are all leading indicators looked at when assessing for health disparities. Analysis of demographic trends as they relate to poor health and need for public health services indicates that where poverty is the highest, poor health outcomes are the greatest. Disparities in the community, whether we look at race, ethnicity, education, or socioeconomic statuses are all evident within these zip codes. As expected, health outcomes are significantly poorer than those of the county as a whole.

In 2014-2018, 14.5 percent of Erie County residents lived in poverty. That’s 128,781 people struggling to survive. An estimated 21.6 percent of children under 18 were below the poverty level, compared with 8.7 percent of people 65 years old and over. An estimated 13.8 percent of people 18 to 64 years were below the poverty level.

Many families throughout Erie County have urgent concerns and face barriers to the programs and services that could help them. They live paycheck to paycheck, juggling financial obligations and making trade-offs as they try to make ends meet on limited incomes. Economic need in Erie County increased slightly between 2011 and 2017. Half of single parents live in poverty. This rate is more than double the poverty rate for married couples with children. Poverty limits opportunities for quality housing, safe neighborhoods, healthy food, living wage jobs, and quality education. As poverty and related stress increase, health worsens.

Transportation is an enormous barrier to jobs and services. Many jobs are located far away from neighborhoods. The cost of public transit creates barriers for both providers and residents. Walkability of streets and sidewalks creates challenges to getting around within neighborhoods. Some high school graduates are not job ready and lack basic reading and math skills. Underemployed workers do not qualify for funding for training. Not enough trainers offer the wraparound services that residents need to succeed. Some individuals with urgent health needs face long waits for a medical appointment.

About 338,000 people live in or near poverty in Erie County. That is the as much as the entire population of the city of Buffalo. Poverty is concentrated and most persistent in urban areas. But it is also fairly prevalent in the Erie County’s rural and suburban areas where access to jobs and services is more limited, especially without a car. Finding ways to increase access to education and training, reduce housing cost burdens, and provide flexible transportation options are universal needs in communities across Erie County.

Obesity remains a top concern of residents of Erie County, followed closely by Mental Health. Related to obesity is the lack of access to healthy foods and opportunities for safe and affordable physical activity. Residents of the city of The mission of the Erie County Department of Health (ECDOH) is to promote and protect the health, safety, and well-being of Erie County residents through active prevention, education, enforcement, advocacy and partnerships. 34

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

Buffalo, of color, young age and low income were more likely to feel food insecure. The ALICE report from the United Way of Buffalo & Erie County details how many families while not living at the poverty line are struggling to keep up with basic needs such as food and shelter. Not surprising there was a disconnect between the educational level of respondents and the reported income mirroring a trend seen nationwide that jobs are not keeping pace with the rising cost of living.

To address these challenges we looked at what services are already in place and reviewed models from other places in the region, country, and world that demonstrate how other communities have addressed similar issues. These models served as starting points for understanding how strategies can be successfully implemented in this community Obesity and its associated diseases is our biggest health problem right now. The increase in obesity appears to have slowed over the past five years and is below the national average but it is not a problem that is going to go away. Obesity still affects 25.5% of the adult population. Nearly a quarter of the adult population still report consuming regular soda or other sugar-sweetened beverages daily and the consumption of fruits and vegetables remains stubbornly low at 22.4%. Improved nutrition standards, polices and organizational practices at worksites and in public spaces where food is available to the public increases both awareness and access. Over time implementing food standards may help to lower the risk factors for chronic diseases associated with over consumption of unhealthy food.

Nearly 95,000 residents in the Buffalo and Erie County live in neighborhoods designated by the USDA as "food deserts" where healthy food access is limited and food insecurity is high. Nearly half of these individuals live in or near poverty, so being able to afford food is a constant concern for many. Not having a car adds another obstacle, and 22% of households in food deserts do not own a vehicle. Overcoming these barriers to make healthy food more affordable and accessible is critical. A healthy diet can help prevent obesity and curb related health conditions like diabetes, heart disease, and hypertension. Moreover, many strategies to improve healthy food access, like community gardening, also benefit physical and mental health. Erie County Department of Health already works with partners in the Community to improve access to healthy and nutritious food. ECDOH are active members of the Buffalo & Erie County Food Policy Council, The Healthy Corner Store initiative and we are currently working on getting anchor institutions to adopt healthy food service guideline. ECDOH and Erie County Department of Parks Recreation and Forestry just completed a set of Healthy Food Service Guidelines that all vendors supplying concessions in Erie County Parks must adhere to. ECDOH built to Blood Pressure self-monitoring and have installed them in the corner stores.

Data Analysis Process

The CHA & CHIP Planning Group (CCPG) developed a data collection plan which included a consumer survey, community and provider input from several community and provider focus groups and data gathered from vital statistics, epidemiology data bases, research studies, hospitals and other sources. Regional, state, county, sub-county data, and data gathered in the Community Health Assessment Survey, developed by the group, were analyzed to review trends and compare Erie County’s health indicators to state goals and local averages. The collected data was then used to conduct a comprehensive and reliable assessment of the population’s health status and health challenges. The group reviewed data from many resources, including, but not limited to: • The New York State Community Health Indicator Reports • US Census American Community Survey • Bureau of Vital Records (2016) Vital Records (Vital Statistics). V. S. Unit, NYS DOH • Public Health Collaborative (PHC) Keys to Health (2018). • Department of Education. (2017-2018). High School Graduation Rates. NYSDOEducation. data.nysed.gov. • MC-CHIW (2016).

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

• Erie County Community Health Improvement Plan 2016-2018. • EC Department of Public Health Epidemiology Reports • Youth Risk Behavior Survey Report: Buffalo City School District. 2017 • Erie County (2017). • Chronic Disease Report NY, ECDPH: 1-27. • The Erie County Medical Examiner’s Office, 2019 • Erie County Youth Risk Behavior Survey. ECDPH • Erie County Office of Mental Health (2018). • CHA Community Focus Group Report • CHA Stakeholder/Provider Focus Group Report • NumbersInNeed.org • PHC Keys to Health

After all primary and secondary data were reviewed and analyzed by the CCPG; the data suggested a total of 39 distinct issues, needs and problems to be considered for selection to be addressed in the Community Health Improvement Plan. Members of CCPG team met in June of 2019 to review the identified problems and determine the final priorities. The methodology used to determine the priority and focus areas included rating each issue/need by four different criteria:

(i) magnitude of the problem, (ii) impact on other health outcomes, (iii) impact social determinants of health have on the problem (iv) the capacity (systems and resources) to address the issue/need

Using this rating system the CCPG took a deeper look at the top six issues, needs and problems were able to narrow the priorities by applying further selection criteria. as based on this rating system criteria prioritization and looking at evidenced-based solutions, the following top three priorities, as aligned with the NYS Prevention Agenda (NYS PA), are the areas that the Erie County Department of Health, Kaleida Health Systems and Catholic Health Systems will be working on for the next three years: (1) prevent chronic diseases with a disparity concentration on poverty; (2) Promote Healthy Women, Infants and Children; and (3) promote well-being and prevent mental health and substance use disorders with a disparity.

Hospital and Community Partners

Although the hospitals and the Erie County Department of Health will each be submitting their own Community Health Improvement Plan, they worked together to develop their plans, partnered on some initiatives and made certain that their priorities and interventions aligned and complemented each other. The collaborative approach taken will leverage the efforts and resources of all health organizations in the community, resulting in increased effectiveness and sustainability of initiatives and interventions, reduced service duplication and clear identification of system gaps.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH Community Health Improvement Plan (CHIP) 2019-2022

Following are the top three priorities areas, as aligned with the NYS Prevention Agenda, selected by Erie County Department of Health (ECDOH), Kaleida Health Systems and Catholic Health Systems to work on for the next three years: (1) prevent chronic diseases with a disparity concentration on poverty; (2) promote Healthy Women, Infants and Children; and (3) promote well-being and prevent mental health and substance use disorders with a disparity.

ECDOH will be working on these priorities in the following focus areas and goals:

Priority Area 1 - Prevent Chronic Disease (addressing the disparity of poverty); focus area 1: Healthy Eating and Food Security; Goal: 1.1: increase access to healthy and affordable fruits and vegetables; focus Area 2: Physical Activity; Goal 2.2: promote school, child care, and worksite environments that support physical activity for people of all ages and abilities; focus area 3: Tobacco Prevention; Goal: 3.1: prevent initiation of tobacco use, including combustible tobacco and electronic vaping products by youth and young adults; Goal 3.2: promote tobacco use cessation, especially among populations disproportionately affected by tobacco use including: low SES, frequent mental distress/substance use disorder; LGBT; and disability; focus area 4: Preventive Care and Management; Goal 4.2: increase early detection of CVD, diabetes, prediabetes and obesity; Goal 4.4: improve self-management skills for individuals with chronic conditions;

Priority Area 2 – Promote Healthy Women, Infants and Children; Focus Area 2: Perinatal & Infant Health, Goal: 2.1 Reduce infant mortality and morbidity; Goal: 2.2 Increase Breastfeeding Intervention; Focus Area 4: Cross Cutting Principles applied for Healthy Woman, Infants, & Children.

Priority Area 3 – Promote Well-being and Prevent Mental and Substance Use Disorders: Focus Area 2: Prevent Mental and Substance Use Disorders; Goal 2.2: Prevent opioid and other substance misuse and deaths

CATCH is an acronym for Coordinated Approach to Child Health. It is an evidence-based coordinated school health program designed to improve nutrition and physical activity in students attending kindergarten through 8th grade. Another CATCH program, The CATCH My Breath will be used, along with the American Heart Association’s Quit Lying program to address priority area 3, goal 3.1. Other evidenced based programs utilized in ECDOH’s CHIP are Stanford’s Chronic Disease Self-Management Program (CDSMP) and Diabetes Self-Management Program (DSMP) and the National Diabetes Prevention Program (DPP) to address priority area 1 goal 4.2 and goal 4.4.

Note: The United Way, ECDOH and BPS have been working on Catch since 2017. In the pilot schools the evidence that it works is already pretty significant:

CATCH Results • In the Fall of 2017, 31% more students scored in the healthy fitness zone in CATCH schools (31% vs. 23.6%).

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

• In Spring 2018, 39% more students scored in the healthy fitness zone in CATCH schools (37.7% vs. 27.1%) • In CATCH schools about 10% more students reported optimal fruit and vegetable consumption during the 2017- 2018 academic year (44% vs. 49% in the first collection point and 46% vs. 51% in the second collection point). • After 2017, we started to train the other Buffalo schools on CATCH so there isn't a control group any longer to compare.

The attached Community Health Improvement Plan/ work plan provides a clear outline of how the Erie County Department of Health will address these priorities

References – Data Sources

Many data sources are referenced directly in the document

1. U.S. Census Bureau, Population Estimates Program (PEP), Updated annually. Population and Housing Unit Estimates 2. United States Census Bureau, American Community Survey Data Set 2014-2018

i http://quickfacts.census.gov/qfd/index.html# ii http://buffalo.sayyestoeducation.org https://numbersinneed.org/ Prevention agenda dashboard https://health.data.ny.gov/Health/Prevention-Agenda-2013-2018-Tracking-Indicators-Co/7j59-48xy https://www.wkbw.com/news/buffalo-ranked-among-top-10-cities-for-public-transit • The New York State Community Health Indicator Reports • US Census American Community Survey • Bureau of Vital Records (2016) Vital Records (Vital Statistics). V. S. Unit, NYS DOH • Public Health Collaborative (PHC) Keys to Health (2018). • Department of Education. (2017-2018). High School Graduation Rates. NYSDOEducation. data.nysed.gov. • MC-CHIW (2016). • Erie County Community Health Improvement Plan 2016-2018. • EC Department of Public Health Epidemiology Reports • Youth Risk Behavior Survey Report: Buffalo City School District. 2017 • Erie County (2017). • Chronic Disease Report NY, ECDPH: 1-27. • The Erie County Medical Examiner’s Office, 2019 • Erie County Youth Risk Behavior Survey. ECDPH • Erie County Office of Mental Health (2018). • CHA Community Focus Group Report • CHA Stakeholder/Provider Focus Group Report • NumbersInNeed.org • PHC Keys to Health

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

Community Contributors and Roles

Organizati Data Survey Data Report Solicited Assisted Identificati Review and Proposed on review and Design Compilatio Writing Survey with on of Key Critique of Implementa planning n Response Communit Stakehold Plan tion Partner process s y ers Conversati ons American X X X X Heart Associatio n American X X Lung Associatio n Bertrand X X X Chaffee Hospital BestSelf X X Behavioral Health Buffalo X X X Prenatal Perinatal Network Buffalo X X X X State College Catholic X X X X X X X X X Health Systems Crisis X X Services D’Youville X X X College EC Dept of X X X X X X X X X Health Jewish X X Family Services Kaleida X X X X X X X X X Health Systems Parent X X Network of WNY Population X X X X X X X X X Health Collaborati ve The Arc X X Erie County New York UB/MD X X United X X X X X Way of Buffalo & Erie County University X at Buffalo Clinical andThe mission of the Erie County Department of Health (ECDOH) is to promote and protect the health, safety, and well-being of Erie County residents through active prevention, education, enforcement, advocacy and partnerships. 39

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

Translatio nal Research Center University X X X X at Buffalo Dept of Family Medicine Visiting X X Nursing Associatio n of WNY WNY X X Veterans Housing Coalition, Inc.

COUNTY OF ERIE MARK C. POLONCARZ COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH COMMISSIONER OF HEALTH

Survey Distribution Sites

Location Zip Code Paper Copies Emailed/Posted/Social Media 3 County Hospital webpages X Adolfs Old First Ward Tavern 14204 X Alba De Vida 14201 X Bertrand Chafee Hospital 14141 X X Buffalo Research Registry X Catholic Health Hospital webpage X Clarence Community Center 14031 X Cooks Bar & Grill 14210 X Eastern Hills Mall 14221 X EC Dept of Social Services 14202 X EC DMV Downtown Location 14202 X Eden/North Collins Food Pantry 14111 X Erie County Website X Facebook pages (personal) of partners X Faith Community Nurse Group X Ford Motor Plant 14219 X Galleria Mall 14225 X Great Lakes Dental Tech 14150 X X Hispanics United 14201 X Independent Health Medicaid Member 14221, 14127, 14043 X Engagement Kaleida Health Employee newsletter X Kaleida Health Public Website X LK Painter Community Center 14034 X Main Place Mall 14202 X Mercy Hospital Emergency Room 14220 X Native American Community Services 14207 North Collins Food pantry 14111 X North Collins Food Pantry 14111 X Springville Auction & Farmer’s Market 14141 X Springville/Concord Food Pantry 14141 X St. Joseph Emergency Room 14225 X St. Luke’s Mission of Mercy 14211 X St. Paul AME Zion Church 14210 X Tops in Depew 14043 X Tops in Derby 14047 X Univera Healthcare X